HomeMy WebLinkAbout9865-zFORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Town Clerk's Office
Southold, N.Y.
Certificate Of Occupancy
No....Z..1..0.1.i./f ...... Date ..... Allg~t .27, ................ 19..80
THIS CERTIFIES that the building ................................................
Location of Property ...... .~.0..~.~..~...8~..8.~..1~...R.O.a.d. ! .................. .C.11.~.c..h.o..l~..e. ......
House No. Street Hamlet
County Tax Map No. 1000 Section .... 'J .'1.1 ..... Block ...0(~ .......... Lot 0.1.Q .............
Subdivision...Nassau. Po.i.n~ · Cl.ub. P~oD. ·Filed Map No ......... Lot No ..............
conforms substantially to the Application for Building Permit heretofore filed in this office dated
...... Jl&ly..18 ....... , 19..7.~ursuant to which Building Permit No ..... 9865. Z ..........
dated ....... JlllZ .2(; ............. 19..7.1~, was issued, and conforms to all of the requirements
of the applicable provisions of the law. The occupancy for which this certificate is issued is .........
·.. Breezeway. and. one. ce~..garage, erlditi~m ................................
The certificate is issued to ...... .~.ilfr.e.d .P,. DeBe~y. ................................
~owner, I~
of the aforesaid building.
Suffolk County Department of Health Approval ..........................................
UNDERWRITERS CERTIFICATE NO ......... ~1.399.6..T_~.......... _/ ..................
Building Inspector
Rev 4/79
FOItM NO. ~
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, N~ Y.
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PP, EMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
N? 9865
Permission is
hereby .... ~':"~'~i'~~'''~'~'~''~
granted to: ,/ __ £ ,,--'
, .......... /z,,~.,.,~.,...~...-.? .......
...... ~~_,.~...~,~...~~..¥~..~'_:../
at premises located at ...././...~...~.../'..../~.~,~-'-~.....~..~_~_____(____
........ , ................. ,:.. ...................................... ;....~:., ~.. ~.~.7..~...~...~/,~,~,
..~,,~.'.....,iL~....:....~/~.,~ ~~~..~...... './,. ~.....z...~__ / '
Bu~ In e t
FORM NO. 6
TOWN OF SOUTHOLD
Building Department
Town Hall
Southold, N.Y. 11971
APPLICATION FOR CERTIFICATE OF OCCUPANCY
Instructions
A. This application must be filled in typewriter OR ink, and submitted in duplicate to the Building Inspec-
tot with the following; for new buildings or new use:
I. Final survey of property with accurate location of all buildings, property lines, streets, and unusual
natural or topographic features.
2. Final approval of Health Dept. of water supply and sewerage disposal--(S-9 form or equal).
3. Approval of electrical installation from Board of Fire Underwriters,
4. Commercial buildings, Industrial buildings, Multiple Residences and similar buildings and installa-
tions, a certificate of Code compliance from the Architect or Engineer responsible for the building.
5. Submit Planning Board approval of completed site plan requirements where applicable.
B. For existing buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-existing"
land uses:
1. Accurate survey of peoperty showing all property lines, streets, buildings and unusual natural or
topographic featu res.
2. Sworn statement of owner or previous owner as to use, occupancy and condition of buildings.
3. Date of any housing code or safety inspection of buildings or premises, or other pertinent informa-
tion required to prepare a certificate.
C. Fees:
1. Certificate of occupancy $5.00
2. Certificate of occupancy on pre-existing dwelling or land use
3. Copy of certificate of occupancy $I.00
$5.00
Date ......................
/
New BuildingS/. ...... ~,~1~.~.'~' Old or Pre-existing Building ............ Vacant Land .............
Location of Property. ~. ,~..~. ,~,~T'?.'.'). .~o.~'.~ .............. ~.~ ,¢,~, .~,, ~.,, ~,,o. ~, d,,~, ..........
House No. Street Hem/et
Owner or Owners of Property .............................................
County Tax Map No. 1000 Section ...... .1.1 .'] ...... Block .....8.ZI', ........ Lot... ~) ............
Subdivision Nassau Point Club Prop. F ~a ~n No., .......... L~,~o.
Permit No. ( Applicant ~11.~
Health Dept. Approval ........................ Labor Dept. Approval ........................
Underwriters Approval ..... N3.9.9 ./+7.fl ...........Planning Board Approval ...................
Request for Temporary Certificate ..................... Final Certificate ................
Fee Submitted $ .... ~ {7 .....................
Rev, 10-10-78
January 21, 198 i. i
The Building Department
Town of Southold
Main Street
Southold, New York
Gentlemen: Re:
Certificate of Occupancy, Garage
Debany Residence, Carrington Road, Nassau Point
Tax Map N.o. 111.-6-10
In July-August of 1978, Gabrielsen Builders of Herricks Lane, Jamesport,
New York, erected a garage on our property, as captioned above. (See
attached contract.)
In a review of my file on this property, I am unable to locate the
original Certificate of Occupancy for the garage. I would like to
get a duplicate copy as soon as possible. I would appreciate your
prompt reply with instructions to me and appropriate fees.
Thank you for your earliest attention to this request.
Very~ruly yours,
65 Cambridge Avenue
Garden City, NY 11530
Enclosure
CC: Tom Gabrielsen
Gabrielsen Builders
Mr. Gabrielsen came in 1/27/87 and paid $I0.00 for copy of
Certificate of Occupancy Z]01]4 for Mrs. Debany.
GABRIELSEN BUILDERS
Herricks Lane
JAMESPORT, NEW YORK 11947
(516) 722-4927
Page No. of Pages
CITY, STATE AND ZIP CODE
JOB NAME
JOB LOCATION
ARCHITECT
We hereby submit speclbcatlons and eshmates for:
JOB PHONE
~[~ ,~r~l:~/t~' hereby to furnish material and labor - complete in accordance with above specifications, for the su~o~~
~avme~lo be made as tollows: .
r,eptanre of groposal--The abo~e prices, spec,ficatlo.s /~/~ '., / / . --~
a d conddio~s are sahsfactory and are hereby accepted. You are authorized Signature ~.~Z ~ [- ~w~~_._~ ~
Date of Acceptance: . ~ /.~ ]~ 7~lgnature .~ ~ ~
:~2/?~/~FROM ALPHABETICAL LISTING OF TAX ROLL
BOOK ..... __PAGE-- US SCHOOL DISTRICT
NAME OF OWNER(S) OF PROPERTY
LOCATION OF PROJECT-PROPERTY
TOWN TAX MAP DIST. # SHEET #
COUNTY TAX # 1000 , ___ ///
Dist. Section
~!ock Lot
FIL~ ~ ~ ~ ~ .~OT~ ~ -, 3~,ZON~ DISTRICT,.
FLOOD ZONE __( ~L) ~-'~:/~ Y~' ~/~/~
~PROV~,S OF: ,CO~ ~TH D~T.
_UNDERWRITERS. ~39 ?gl/, PLANNING BO~.________
ZONING BOARD OF APPEALS
WETLAND-TOVN BOARD D.E. C.
ASSESSOR CARD PROPERTY FILE CARD
Use other side for Property Description and other information.
THE NEW YORK BOARD OF FIRE UNDERWRITERS
p111 BUREAU OF ELEGTRICITY~
F~ 85 ,JOHN STREET NEW YORK, NEW YORK 10038
THIS CERTIFIES THAT
on/y th~ e/eetdca/equipments a~ deser/bed be/ore and introduced ~y ~he app/iean t named on the above application
~llfred Pabany, n/o/c C.rrlao~on ~d,~ C~tchogue~
in the followlng loeation; [] Basement [] Ist Fl. [] Snd Fl. ,Gal"ago Section Block Lot
was exarnined on ^ U.q UG ~' 2~[~. ~ 1~'78 and found to be ~n compl~ance wlth the requlrornents of shis Board.
2 2 2 2
DRYERS I r4JRNACE ~TORS
RANGES
OTHER APPARATUS:
TIME CLOCKS I L UNIT HEATLIIS
EXHAUST FANS
DIMMERS
I-GoF.I,,
~et'tl'l'uck. Lol. 11952 LIc.242 E N,~OaR
T~is certificate must not be olterecl in on), mon~r;* return to the office ot the Boord it incorrect. Inspectors mo*/ be ~d~ntifie~ by 'their cr~ls.
COPY FOR BUILDING DEPARTMENT, THIS COPY OF CERTIFIC~.T~ MUST NOT BE ALTERED IN ANY MANNER.
TOWN OF SOUTHOLD
OFFICE OF BUILDING INSPECTOR
TOWN HALL
SOUTHOLD, N. Y. 11971
August 11, 1980
Gab~ielsen Builders
He~icks Lane
J~mespo~t, N.Y.
Dear Sir: :
This is to advise you that the job under Building Permit
No, 9865Z issued to W.P. DebanY on
July 26. 1978 for appears to be
completed as of our last inspection. Before you can legally
use or occupy this structure a Certificate of Occupancy must
be issued,
Please fill out the enclosed form and return same to
the above office. There is a fee of $5.00 for a Certificate
of Occupancy
Thank you for your prompt attention.
Very truly yours,
GEORGE H. FISHER
Sr. Building Inspector
encl.
F
APPROVED AS NOTED
FE
NOTIFY BUILDING DEPARTMENT AT
765-2660 9AM to 4PM FC)R REQUIR. ~ "~'
ED INSPECTIONS, I ~
1. BEFORE BACKRLLING FOUNDA-
TiON OR START F~ING
2. FRAMIHG INSPECTION
3. IEFO~E ¢OYERIHG PIPES OF ~N¥ KIND
4. FIK4L WHEN JOB COMPLETED
NOT RESPONSIBLE K~ DESIGN
:.~ .;..,-:-,.~,,,,r..~._..~'~, ',, ~ ~ 1I' ~ '~" ~""'~ ~'"'"'"
,,J / F__. b.,.J
· · . .FOUNDA,r-ION PL.J"A 1",,/ '
H O,,4 $~'
t
WAy
J 81 ~
GA~AB~
~' SLA~
qL3" ~o.
FORM NO.
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, N. Y.
....... .......... ...................
.
.......
APPLICATION FOR BUILDING PERMIT
INSTRUCTIONS
a. This application must be completely filled in by typewriter o~ in ink and submitted in triplicate to the Building
Inspector, with 3 sets of plans, accurate plot plan to scale. Fee according to schedule.
b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets or
areas, and giving a detailed description of layout ofproperty must be drawn on the diagram which is port of this application.
c. The work covered by this application may not be commenced before issuance of Building Permit.
d. Upon approval of this application, the Building Inspector will issue a Building Permit to the applicant. Such permit
shall be kept on the premises available for inspection throughout the work.
e. No building shall be occupied or used in whole or in part for any purpose whatever until a Certificate of Occupancy
shall have been granted by the Building Inspector.
APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the
Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or
Regulations, for the,Construction of buildings, additions or alterations, or for removal or demolition, as herein described.
The applicant agre~fs to comply with all app cab e aws ordinances building code, housina code, and regulations, and to
adm t author zed nspectors on premises and r~ bu Id ngs for necessary nspect ans.
(Signature of applicant, or name, if a corporation)
(Address of applicant)'
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
Name of owner of premises ..... 4~..~. .......
If applicant is a corporate, signature of duly authorized officer.
(Name and title of corporate officer)
Builder's License No ...... ./.~).~.,~...;~.~.../. ...................
Plumber's License No .................................................
Electrician's License No .............................................
Other Trade's License No ...............................................
1. Location of land on which proposed work will be done. Map No.: ............ .~.~...~.. ................. Lot No....~.?..~?... ............
Street and Number .~ ~'47/..z~..~..~ .~...~J~..~?.../....~.~.,C~',d~..~. ........................................................
Municipality
2. State existing use and occupancy of premises and intended use and occupancy of proposed constructiog.:
a. Exisiting use and occupancy ......... ,~,~Z~..~.4~.~....4K'..'./.~.../~...~,~; ....... ~..~.~.~....-~.....~_Z.~...,,~..../,.~...~.
b. Intended use and occupancy ......... ..~.~.~......~..(~.,;~......~4~/../J~,~.~. ....... ~./.Y.?.~......,~...~.~..~..-(~,.~...'...x~..'.~...;
/
3. Nature ~f worrZ (check which applicable): New Building .............. dition .... ~ ............. Iteration'. ......... ~. ......
Repair .................. Removal .................. Demolition .................... Other W~-'~ ...C~,~.~......q~..!~.....~.,f~.~'.~.~...,
,~/ (Description)
4. Estimated Cos ..~-..~.O.?.:..~...~.. .................................. ' e~'../.~..,-.~...' ...........................................................................
t ~ tee z.~'...
(to be paid on filing this application)
5.If dwelling, number of dwelling units ...............~-----~ ............ Number of dwelling units on each floor ............................
If garage, number of cars ....... C).lJ..g~.........C2./~L~ .......................................................................................................
71 If business, commercial or mixed occupancy, specify r)ature and extent of e?ch type of use ............................
Dimensions of existing structures if any: Front ......... .~...~. ............ Rear ...... .~.~.. .................... Depth ...... '~.Y ......
Height ..~..~.~.?...?..~..~f.. Number of Stories ........................................................ 7 .......................................................
Dimensions of same structure with alterations or additions: Front .......... ..~7.~ .................. Rear ....... ."Z.~ ...............
( Hei ht .~ ' Number of Star es O .~'...~.
Depth ....... .~.~. .................. g ...........................
Dimensions of ~entire new construction: Front ...... .~..'..~. ....................... Rear ....... .~...~.... ............. Depth ...~.~j./. .........
Height ...... ~ ........... Number o,f Stories ................ .O...~.¥..~'~.. .................... ? ...................................................................
Size of lot: Front ....... .~....O......~ ................................ Rear ..... '~...~../.. ........................ Depth ..... ].,~..~,/~.~.~.. ........
Date of Purchase ..... /,)~-..c~.~..~..0.,.?i.q.,.?..~.. ................ Name of Former Owner ...~./~.~l~'f].,rd.../~.......~.~.~...~, .t~.... .............
Zone or use district in which premises are situate~ ..,..~'....o~..../~'.....o...~t~_ ...... .~.*..~.~.~..?..~../~.. ................................................
Does proposed construction violate any zoning law, ordinance or regulation: .............. ~....O. ..................................
Will lot be regraded . .......... ~...?. ......... Will excess fill be removed from premises:,,( )_ Yes (~ No
Name of Owner of premises ...~??,~',....t'~,~..~..~ .................. Address .....~..q~;'TT,~-/.~(~l-.4~..... Phone No.
Name of Architect .................. ~ ........................................... Address ....,~,.,,:~ .~.~;~,.~,---' ....Z;~.~:lone No~ .....................
PLOT DIAGRAM
Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions from
property lines. Give street and block number or description according tg, deed, and show street names and indicate
whether interior or corner lot.
12.
13.
14.
duly sworn, deposes and says that he is the app]icanl
(Name of individual signing contract)
above named.
He is the ................................................. ~ ....................................................................................................................
(Contractor, agent, corporate officer, etc.)
of said owner or owners, and is duly authorized to perform or have performed the said work and to make and file
this application; that aH statements contained in this application are true to the best of his know[edge and belief; and
tha~ the work will be performed in, he manner set foffh in the application filed therewith.
Sw~rn%~~~~~his / ] 197 ~/
' r ~ / /.~ ~ (Signature of applicant)